Provider Demographics
NPI:1174745525
Name:GROSS, THOMAS WELCH (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WELCH
Last Name:GROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9636 CHERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-829-7027
Mailing Address - Fax:
Practice Address - Street 1:EMERGENCY DEPT., KAISER PERMANENTE MEDICAL CENTER
Practice Address - Street 2:675 SERENO DR
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589
Practice Address - Country:US
Practice Address - Phone:707-651-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65532207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine